Worldwide wednesday| 2020-04-15 Baka Máté

Bulgakov – writer and doctor

“Follow me, reader!”

The above quote is from the book The Master and Margarita, likely the most well-known work of the famous Russian author Mikhail Afanasyevich Bulgakov- a book probably many of you reading this article have already had the pleasure of perusing. Bulgakov, a genius of the 20th century global literature, left a great impression on the genres of satire and magical realism (the latter being a great movement of the 20th century. However, his fantastic and entertaining works aren’t the only reasons Bulgakov might be of interest to a student studying at Semmelweis University. So why else should you be interested in him? Follow me, reader!


Mikhail Bulgakov was born in 1891 in Kiev (a city that belonged to the Russian Empire at that time) – he was first a Russian, then a Soviet citizen. He attended school in Kiev, including university. And that’s how his life is connected to ours: Bulgakov graduated from the Medical Faculty of Kiev University (today the university is called Taras Shevchenko National University of Kyiv) in 1916.  He started working in healthcare during his university years: he became a volunteer of the Red Cross in 1913 and helped treat patients injured in World War I. Although he gained great experience there, working on the frontlines had its burdens: he was injured on multiple occasions and quickly became addicted to the morphine he took to manage his pain. He never managed to recover from his addiction.

Upon graduating, he started working right away as a physician in the town of Nikolskoye, in Smolensk province, alongside with his first wife. He spent two great years there, even though he was often anxious that without enough experience and a proper mentor around he might endanger his patients, even if his only intention was to help them. This was the time the topic of responsibility became the pivotal subject in his writings. These thoughts led to the completion of his first work, A Young Doctor’s Notebook. This short story collection details the experience of a newly graduated doctor working in the countryside without enough self-confidence or adequate experience, trying to deal with births, tracheostomies and the most difficult one of them all -disobedient patients. (Sky Arts turned the book into an eight-episode anthology series starring Daniel Radcliffe and John Hamm; an episode is about 22-23 minutes long, perfect for those quarantine nights in.) His years in Nikolskoye weren’t only about his fear of failure but also about the chance of a scientific discovery. Bulgakov was often visited by patients suffering from syphilis (causing him to develop an interest in venereology, the branch of science concerned with sexually transmitted diseases) and he discovered an interesting characteristic about them: many of his patients had genu varum (bowlegs). This observation later became known as ’bandy legs sign’ but is sometimes also referred to as Bulgakov’s sign.

Bulgakov, despite this scientific discovery, remained sceptic about his carrier choice, although he waited until the sweeping changes in the beginning of the 20th century to abandon his job altogether. He returned to Kiev in 1918 and joined the Red Army fighting in the Russian Civil War. Later on, he joined the Ukrianian People’s Army and was stationed in the Caucasus to help treat patients. There he contracted typhus (probably from one of the patients) and became seriously ill. Pushed by his already existing doubts and his newly acquired illness, he made the decision to abandon his career and started working as a journalist in 1920.

Although he never worked as a doctor again, the experience he gained during his three years of practice and in medical school had a huge effect on his life and his subsequent works. Precise descriptions of patients, illnesses and health care institutions (be it a doctor’s office or a psychiatric ward) appear in his best-known novel, The Master and Margarita as well. During the writing of the novel his own health was deteriorating. He noticed signs of kidney failure on himself in 1939 (headaches, problems with his vision), and although he had been working on the book since 1928, he only dictated the last draft of the manuscript to his wife in 1940, just four weeks before his death, suffering from uremia. Researchers later found biomarkers characteristic of nephrosis and morphine metabolites on the pages of his manuscript, speaking to his health status while he was working on his masterpiece. The book, a satirical dark comedy criticizing the Soviet Union wasn’t allowed to be published until 1966, and the uncensored version was only published years later, in 1973.

Interestingly, the publishing of the novel coincides with the time postmodernism started to develop. Bulgakov’s work, with its intertextuality, could just as well be a great example of that art movement. Still, Bulgakov was decades ahead postmodern artists, since his novel wasn’t allowed to be published for about 30 years.

It’s not easy to sum up the novel’s story – there are quite a few storylines that rarely ever meet. In the beginning of the book Satan and his companions arrive in Moscow in the 1930s and come into conflict with the artistical and political elite of the city. Meanwhile we are introduced to Jerusalem and Pontius Pilate living 2000 years ago, which also happens to be the main topic of the Master’s writing, who’s struggling with mental health issues. The second part of the novel is about the re-encounter of the mysterious Master and his love, Margarite, while the parallel storyline tells us about the crucifixion of Jesus. Besides the main plotline the novel offers several subplots and interludes, making it hard to fully describe the storylines in and of themselves. That’s why I recommend you read this book during these times of quarantine, so that you can fully get to know each storyline.

Despite having left the medical field early on, Bulgakov always possessed the traits necessary to become a great healer (although, characteristically, he tried his very best to cover that up with his mocking attitude). To prove that point, I’d like to share two of his quotes with you, at the end of this article:

“Each person ought to be a doctor, in the sense of disarming all the invisible enemies threatening life.” 

If you care about your digestion, my advice is – don’t talk about bolshevism or medicine at the table.”